Skirted Prosthetic Valves Are Associated With Increased Risk of Subclinical Leaflet Thrombosis Following Transcatheter Aortic Valve Replacement: A Multicenter Study

Background: Subclinical leaflet thrombosis (SLT) is associated with an increased risk of thromboembolic events, valve dysfunction, and mortality in patients undergoing transcatheter aortic valve replacement (TAVR). However, data on the incidence and risk factors for SLT in patients undergoing TAVR using self-expanding valves (SEVs) remain limited. Methods: This study included patients who underwent TAVR using SEVs and received a postoperative four-dimensional computed tomography scan within six months at Beijing Anzhen Hospital and Fuwai Hospital. SLT was defined as the presence of hypo-attenuated leaflet thickening (HALT) with or without reduced leaflet motion (RLM), and characterized by increased leaflet thickness affecting one or more leaflets. Univariate and multivariable logistic regression analyses were conducted to explore the relationship between variables and the occurrence of SLT. Results: A total of 311 patients (mean age 72.02 ± 8.23 years, 52.4% males) were included in the analysis. HALT was detected in 91 patients (29.3%), while RLM was observed in 45 patients (14.5%). Most HALT (81.3%) and RLM (73.3%) cases were classified as grades 1–2. Multivariable logistic regression analysis revealed that using skirted prosthetic valves was significantly associated with SLT (adjusted odds ratio: 2.999; 95% confidence interval: 1.250–7.397; p = 0.015). Conclusions: Over one-quarter of patients undergoing TAVR using SEVs developed SLT within six months. The use of skirted prosthetic valves was independently associated with SLT.